Information on fibromyalgia, a syndrome that causes people to feel pain even when there is no injury. Covers symptoms and how it is diagnosed. Includes info on treatments such as medicines, exercise therapy, and cognitive-behavioral therapy.

Fibromyalgia

Topic Overview

What is fibromyalgia?

Fibromyalgia is widespread
pain in the muscles and soft tissues above and below the waist and on both
sides of the body. People with fibromyalgia feel pain, tenderness, or both even when there
is no injury or inflammation.

Fibromyalgia can cause long-lasting (chronic) pain. It has no cure. But with treatment, most people
with fibromyalgia are able to work and do their regular activities. When it is not controlled, you may not have any energy. Or you may feel
depressed or have trouble sleeping. But there are many things you can do to help manage your symptoms.

What causes fibromyalgia?

No one knows for sure what causes fibromyalgia. But experts have some ideas, such as:

Nerve cells may be too sensitive.

Chemicals in the brain
(neurotransmitters) may be out of balance.

The deep phase of sleep may be disrupted and affect the amount of hormones that your body releases.

Symptoms
tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, hurt less, or are absent (remissions).
Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.

How is fibromyalgia diagnosed?

Doctors diagnose fibromyalgia based on:

How much of your body is affected by pain. If you have pain above and below your waist and on both the left and right sides of your body, it is considered widespread. The more widespread your pain, the more likely it is that you have fibromyalgia.

How bad your pain and other symptoms are. People who have fibromyalgia usually have pain. They usually also have fatigue, trouble sleeping, and trouble thinking. The more severe these symptoms are, the more likely it is that you have fibromyalgia.

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body,
or tender points. You may also hear these called trigger points.

Cause

Fibromyalgia is a syndrome—a set of symptoms that occur together. Experts have ideas about what may cause it, but there is
not enough evidence to support any one idea. Some ideas include:

Nerve cells may be too sensitive.

Chemicals in the brain
(neurotransmitters) may be out of balance.

The deep phase of sleep may be disrupted and affect the amount of hormones that your body releases.

Many people connect the beginning of their symptoms to a certain event, such as the
flu, an injury or surgery, or emotional trauma and stress. An event of this type combined with other things, such as
increased sensitivity to pain and sleep problems, may lead to
fibromyalgia in some people.

Symptoms

The symptoms of
fibromyalgia vary from person to person. Symptoms can last from days to months or years.

The most common symptoms are:

Widespread deep or burning pain above and below your waist and on
the right and left sides of your body. Pain is more common in the
trunk, neck, low back, hips, and shoulders. It usually gets worse gradually and can interfere
with even simple daily activities.

People
with fibromyalgia have times when their symptoms get worse and other times
when they have milder or no symptoms. Flare-ups of fatigue and muscle and joint
aches are common, especially following physical or emotional stress. Many
people with fibromyalgia say that cold or damp weather, poor sleep, fatigue,
stress, or being too active makes their pain worse.

What Happens

For most people,
fibromyalgia seems to involve a cycle of muscle pain,
increased sensitivity to pain, and inactivity that may be made worse by sleep
problems and fatigue.

Increasing pain causes a person to be less
physically active.

Muscles that aren't exercised regularly are
more likely to be irritated during activity. And it may be that people
with fibromyalgia are more sensitive to pain or have muscles that are more
easily irritated.

The irritated muscles are painful. Some doctors
think that the muscles of people with fibromyalgia stay sore because they don't repair themselves as well as they should.

Muscle pain, sometimes occurring with disrupted
sleep and daytime fatigue, leads to less and less activity.

Although fibromyalgia is a long-lasting (chronic) condition
with no cure, it can be controlled. It doesn't damage the muscles, joints, or
internal organs. Most people adjust to their symptoms and are able to keep working and
doing their daily activities. For more information about managing fibromyalgia, see the Treatment Overview.

What Increases Your Risk

Certain things may make you more likely to have
fibromyalgia. Things that increase your risk (risk factors) include:

Pain management programs can be helpful too. These
typically include a team of doctors, counselors, physical therapists, nurses, and pharmacists who
can help you develop a strategy for pain management. Your personal program may
include medicines, complementary therapies, diet, exercise, and counseling.

Exams and Tests

There are no specific tests that can
confirm a diagnosis of
fibromyalgia. You will likely have
lab tests to make sure that you don't have another condition causing your symptoms. Your doctor will also ask questions about your
medical history and do a
physical exam.

Doctors use a set of criteria
to diagnose fibromyalgia. These include:

Widespread pain. Pain is considered to be widespread if it is above and below your waist and on the right
and left sides of your body.

Other symptoms such as fatigue, trouble sleeping or feeling unrefreshed in the
morning, and trouble thinking. If these symptoms are severe, widespread pain may not be as important in the
diagnosis.

Symptoms that have lasted for at least 3 months.

No other medical explanation for why you
feel this way (for example, another health condition or disease).

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body,
or tender points. You may also hear these called trigger points.

A person may not meet these criteria but may still
have fibromyalgia. That is why diagnosis can be so difficult.

Treatment Overview

There are many steps you can take to
manage your symptoms. Treatment is focused on
managing pain, fatigue, depression, and other symptoms common in fibromyalgia. The goal is to break the cycle of increased sensitivity to pain and decreased
physical activity.

The treatment you need or want may be based on:

How bad your symptoms are.

Whether the condition is disrupting your daily
life.

What kinds of changes in your life you are willing and able
to make.

Exercise

Getting consistent exercise, especially
cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool
exercise is a good example.

It's important to build up your exercise program slowly so
you don't get sore muscles that cause you to want to stop exercising. Working
with a physical therapist familiar with fibromyalgia may be helpful.

Medicines

Medicines are part of the long-term treatment of fibromyalgia. Medicines can help you sleep better, relax
your muscles, or relieve muscle and joint pain. Your doctor may suggest
prescription medicines, such as antidepressants, muscle relaxants, and anticonvulsants. Or he or she may suggest nonprescription pain relievers.

Not all people with fibromyalgia will need, want, or benefit from
medicines. You might need to try one medicine before finding
one that works best for you. You may also find that a medicine that has been
helping your symptoms seems to not work as well over time.

With help, you will be able to
start working on most of these goals at home. You may have a team of health
professionals to help you. To learn more, see Home Treatment.

Because the symptoms of fibromyalgia can come and go, you
may find it hard to judge whether a particular treatment is really
working. Different people may respond differently to each type of treatment. Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated too.

Finding a treatment
can take time. You may have to try several different treatments to find an
approach that works for you.

Prevention

Fibromyalgia can't be prevented or cured. But
treating symptoms may help reduce how long a flare-up lasts.

Home Treatment

Home treatment is the most
important part of treating fibromyalgia. There are many things you can
do over time to treat your symptoms:

Exercise regularly. Of all the
treatments for fibromyalgia, cardiovascular (aerobic) exercise may have the
most benefit in reducing pain and other symptoms and in improving your overall
condition. Work with a physical therapist or other professional who has
expertise with fibromyalgia to build an exercise program that works for you. And then stay with it.

Try to avoid or limit your
exposure to "triggers" or "stressors" that make your symptoms worse. Common triggers include cold or
damp weather, poor sleep, fatigue, physical or emotional stress, and
being too active.

Improve sleep. Sleep disturbances seem
to both cause and result from some of the other symptoms of fibromyalgia, such
as pain. Learn good sleep habits. And try to get enough sleep each
night.

Learn about fibromyalgia. The more you know about fibromyalgia, the more control you
will have over your symptoms. People who feel more in control also tend to be
more active and report less pain and other symptoms.2

Learn ways to manage your
memory problems. Feeling as though you are not
thinking clearly—sometimes called "fibro fog"—increases stress and can make
memory problems worse. Simple things like writing yourself notes can help you
feel more in control.

Have a
good-health attitude, along with these other healthy
habits. It's hard to stay positive when you don't feel well. But a good
attitude helps you focus less on your challenges and feel more healthy.

The best results occur when you take an active, committed
role in your own treatment. You may need to adjust your lifestyle to fit home
treatment, especially regular exercise, into your daily routine. It may take time
to find an approach that works for you. Try to be patient. And keep in mind
that consistent home treatment usually can help relieve or control symptoms of
fibromyalgia.

Medications

Medicines are part of the long-term treatment of fibromyalgia. They may help break the
cycle of pain and sleep problems when symptoms flare up. Not all people with fibromyalgia will need, want, or benefit from
medicines. People with more severe pain, sleep problems, or
depression that disturbs their daily life may find
medicines helpful.

Fibromyalgia symptoms in different people respond to
different medicines. Your doctor may try more than one medicine before finding
one that works best for you. You may also find that a medicine that has been
helping your symptoms seems to become less effective over time.
Talk with your doctor if you are not getting relief. He or
she may try a different medicine or make suggestions for helping find new ways to modify your activity, sleep, and stress.

Medicine choices

Certain types of medicines may be used to
improve sleep, relieve pain and fatigue, and, in some cases, treat depression. These
improvements in symptoms may allow you to feel better and to be more active. Medicines used
for fibromyalgia include:

Atypical antidepressants. These are drugs that don't fit
well into the general categories of antidepressant medicines. Bupropion
(Wellbutrin) is an example of an atypical antidepressant that is used for
fibromyalgia.

Often medicines may be combined (such as fluoxetine and
amitriptyline) for the most effective treatment of symptoms of pain and sleep
disruptions.

Prescription pain medicines, such as tramadol (Ultram), are sometimes used. And they are sometimes combined
with acetaminophen.

Nonprescription pain relievers, such as acetaminophen
(for example, Tylenol) or
nonsteroidal anti-inflammatory drugs (NSAIDS, such as
ibuprofen or aspirin) usually aren't very helpful in treating day-to-day
symptoms of fibromyalgia. But they may be useful in reducing severe pain caused
by a flare-up of symptoms. Check with your doctor if you need to
keep taking these medicines, because they may harm your stomach, kidneys,
or in rare cases, your liver. Your doctor may want to monitor you if you take
acetaminophen or NSAIDs daily.

Other Treatment

Counseling

The pain and other symptoms of fibromyalgia can get worse during stressful times. The good news is that there are a lot of things you can do to lower your stress. For example, research shows that you can change how you think. And how you think affects how you feel.

Here are some techniques you can try on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy:

Complementary and alternative therapy

Most people who have fibromyalgia try some type of
alternative therapy. These therapies may relieve stress, ease
muscle tension, and help you feel better and healthier. Some have been shown to work for many people. But for other therapies, such as tender point injections, there is no evidence that they help.

Complementary and alternative treatments that have been used to treat
fibromyalgia include:

What to think about

You may find one or more
complementary or alternative therapies to be helpful in relieving some of your
symptoms. Keep in mind that there is only limited information about how well these treatments (and others you may have heard about) work for
treating fibromyalgia.

If you have fibromyalgia and are thinking
about trying a complementary therapy, get the facts before you begin. Consider
these questions with your doctor:

Is it safe? Talk with your doctor about the
safety and potential side effects of the treatment. Remember that fibromyalgia
doesn't physically harm you or damage your body. A treatment that could be
harmful may not be worth the risk, especially when its benefits are unproven.
Avoid treatments that may be harmful, such as unusual diets or excessive
vitamin or mineral supplements. (A daily multiple vitamin-mineral supplement is
okay. Try to avoid taking more than 100% of the recommended daily allowance for
any vitamin or mineral unless your doctor prescribes a special
supplement.)

Does it work? Because the symptoms of
fibromyalgia can come and go, you may find it hard to judge whether a
certain treatment is really working. Symptoms of fibromyalgia often improve
on their own. Or the treatment may be causing a
placebo effect that is making you feel better. Keep in
mind that when you get better after treatment, the treatment may not be the
reason for the improvement. Also remember that a treatment that works for one
person may not work for you. It may take time. And you may have to try several
different treatments to find an approach that works for you.

Will it improve my general health? Even if
complementary therapies aren't effective in treating fibromyalgia, many of
them are safe, healthy habits that may improve your general well-being and
may be worth trying.

With a hard-to-treat condition like fibromyalgia,
it can be tempting to jump at the promise of an effective treatment. Be
careful. Avoid products that claim to have a secret ingredient or that claim to
cure fibromyalgia. Avoid those that encourage unhelpful behaviors such as
excessive resting or avoiding activity.

Also make sure you know
how much a treatment is going to cost before you agree to it. An expensive,
unproven treatment that may or may not help you may not be worth the high cost.
Beware of treatment providers or products that require a large financial
investment at the start or a series of costly treatments.

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